October is all about breasts! So, we sat down with Family Medicine Doctor Delores Lee to get her insights on breast cancer in our island community. Dr. Lee, like many family-medicine doctors, is often the first line in diagnosis of breast cancer and remains with each patient throughout their treatment to help navigate their care. In addition, providers like Dr. Lee are largely responsible for post cancer treatment care.
For Dr. Lee, Breast Cancer Awareness is a subject much closer to home with her own mother’s breast cancer diagnosis being a large motivator for her career in medicine. Dr. Lee knows all too well the journey that a woman and her loved ones take in treating and surviving breast cancer, and that has largely served as the driving force behind the work she does to increase breast cancer and breast health awareness.
Dismantling the Myths about Breast Cancer
Dr. Lee educates her patients and the community about breast cancer and has encountered a number of myths surrounding the disease. One major myth she has encountered is the belief that breast cancer only affects women, when in fact men are also at risk of breast cancer. Although not as prevalent amongst men, Dr. Lee says that everyone should be aware and concerned about breast health to prevent late-stage diagnoses. In addition, there are a number of myths surrounding screening and treatment of breast cancer, namely that mammograms are painful and that cancer treatment results in mastectomies – the total removal of breast tissue. Contrary to this belief, early diagnosis mastectomies can largely be avoided and mammograms—perhaps slightly uncomfortable—are essentially painless and takes about 20 minutes. A small price to pay to avoid being apart of the statistics of breast cancer on the island.
The Facts on Breast Cancer in Guam
According to Dr. Lee,breast cancer accounted for 17% of cancer diagnoses in Guam from 2013 to 2017. Specifically, about 34% of cancer diagnoses amongst women in Guam were due to breast cancers which in turn amounted to 9% of deaths amongst female cancer patients on the island during this time period.
However, there is good news as Dr. Lee says that breast cancer rates in Guam are lower than the national average and according to the World Health Organization’s 2020 Guam Fact Sheet, breast cancer accounted for 23% of diagnoses amongst female cancer patients for the year 2020 — a significant improvement. However, Dr. Lee also points out that for the Micronesian community in Guam, there remain barriers to breast cancer screening that put them at risk.
Dr. Lee explains that there is a higher rate of breast cancer in the Micronesian community and that is largely due to the lack of access to care. Affordability and the lack of medical providers in Guam are some of the biggest obstacles that Dr. Lee says create certain health disparities for Micronesians. Furthermore, breast cancer tends to be diagnosed at a late-stage for Micronesian women because of these health disparities, and thus harder to treat.
What is Breast Cancer?
Our bodies create new cells every day to replace old cells. Take for example our skin cells which is shed almost daily and must be replaced; the same goes for cells that allow the breasts to function. Breast cancer is the result of a series of mutations that disrupt this process of new cell creation. It can be either inherited (genetic) or random and these mutations create runaway cell growth that eventually become a mass in the breast and can start in the breast ducts or in the glandular tissues of the breasts. These masses, also referred to as tumors, block other cells from functioning properly especially through consuming the nutrients in the breasts that would otherwise go toward normal cell function.
Diagnosis and Treatment
The first step in diagnosis and treatment of breast cancer is an annual screening mammogram which is an x-ray using low radiation to identify points of concern. When a doctor identifies points of concern, they recommend a diagnostic mammogram which takes images of more views and angles of the breasts to get a clearer picture of the identified mass. From this point, an ultrasound and MRI may be conducted to further understand the characteristics of the mass, and to determine whether it is highly suspicious for malignancy.
Following the MRI or ultrasound, a biopsy guided by x-ray or ultrasound is conducted to test the mass for cancer. If the mass does test positive for cancer, then the patient will undergo a lumpectomy or mastectomy to remove the cancerous cells from the breasts. It is after this stage that the stage of the cancer and treatment can be determined.
For advanced stages of breast cancer chemo or radiation therapy may be needed and the duration of this therapy is dependent on the stage of the cancer. These treatments are managed by medical oncologists who specialize in these therapies for cancer patients. Radiation and chemotherapy are directed at killing cancer cells and reduce the size of the mass. Tamoxifen and Raloxifene are then used in post cancer treatment to reduce the risk of recurrence.
Am I at Risk?
Increased risk for breast cancer can be due to both lifestyle and genetic factors. Those with a family history of breast cancer are more likely to be diagnosed with the disease and are often screened sooner for breast cancer. There are also some lifestyle related factors that can increase your risks such as obesity and excessive alcohol consumption. Naturally, maintaining a healthy weight and diet, along with reducing alcohol intake can be effective means to reduce these risks.
Breast Health Awareness
Medical science has come a long way especially in the diagnosis and treatment of breast cancer. One increasingly important initiative within modern breast cancer prevention is breast health awareness which Dr. Lee feels is important to practice as soon as a woman starts to develop breasts. So, what does breast health awareness entail?
Dr. Lee wants all women to pay attention to the look and feel of their breasts. Of course, no two busts are exactly the same and thus the unique characteristics of your breasts are important to remember as you age. Breasts grow and change as you age, and Dr. Lee says that understanding and being familiar with how your breasts are developing is key to maintaining good breast health. Should there be anything unusual about your breasts that’s when Dr. Lee encourages women to get their primary care physician involved in the conversation.
In the past, women were encouraged to conduct self-breast exams within which a woman would go through certain steps to identify areas of concern herself. Dr. Lee warns that medical providers are largely moving away from these exams due to a number of reasons, the biggest being that self-breast exams cause unnecessary anxiety around breast health. Furthermore, breast exams in general are tedious and requires specific medical expertise to be conducted correctly.
Breast Cancer Awareness
Cancer is nothing new to our small island community, and that’s the main reason why Dr. Lee feels that Guam has made great strides in awareness. Older generations, she explains, may have felt ashamed of their cancer diagnoses and would often endure their treatment alone. Understandably, it’s this isolation that Dr. Lee says can be counterproductive toward recovery as a positive approach and attitude toward treatment is very important in surviving cancer. Times have changed since; more courageous women are willing to share their stories and Dr. Lee hopes to see this community involvement and support in our island’s future. For all who want to stay on top of their breast health, Dr. Lee leaves us with this tip: “Know your breasts, know when there’s a difference, and when there’s a difference, please see your doctor.”
About Dr. Lee
Dr. Delores Lee is a family-medicine doctor at Evergreen Health Clinic in Maite, Guam with over eight years of experience in the medical field. Dr. Lee attended medical school at the University of Hawaii John A. Burns School of Medicine where she became a Doctor of Medicine (MD) in 2013.